Top

Published in:

01-02-2018 | ORIGINAL ARTICLE

Influence of the recipient body mass index on the outcomes after kidney transplantation

Authors: Juliane Liese, Nils Bottner, Stefan Büttner, Alexander Reinisch, Guido Woeste, Markus Wortmann, Ingeborg A. Hauser, Wolf Otto Bechstein, Frank Ulrich

Published in: Langenbeck's Archives of Surgery | Issue 1/2018

Abstract

Purpose

The relationship between the body mass index (BMI) of kidney transplant recipients and outcomes after kidney transplantation (KT) is not fully understood and remains controversial. We studied the influence of BMI on clinically relevant outcomes in kidney transplant recipients.

Methods

In this retrospective single-centre study, all patients who underwent kidney transplantation at our institution between January 2007 and December 2012 were included. Demographic data and BMI were correlated with the clinical course of the disease, rejection rates, delayed graft function rates, and graft and patient survival.

Results

During the study period, 384 single KTs (130 women and 254 men) were performed. Seventeen percent of the transplants were transplanted within the Eurotransplant Senior Programme (ESP). Most of the transplants were performed using organs that were obtained from donors after brain death (DBD), and living donor kidney transplants were performed in 22.4% of all transplants. The median BMI of the recipients was 25.9 kg/m². Additionally, 13.5% of the recipients had a BMI of 30–34.9 kg/m² and 3.9% had a BMI >35 kg/m². A BMI >30 kg/m² was significantly associated with primary non-function of the kidney (p = 0.047), delayed graft function (p = 0.008), and a higher rate of loss of graft function (p = 0.015). The glomerular filtration rate 12 months after KT was significantly lower in recipients with a BMI >30 kg/m². Multivariate analysis revealed that recipient BMI, among other factors, was an independent risk factor for delayed graft function and graft survival. Patients with a BMI >30 kg/m² had an almost four times higher risk for surgical site infection than did recipients with a lower BMI.

Conclusions

Increased BMI at kidney transplantation is a predictor of adverse outcomes, including delayed graft function. These findings demonstrate the importance of the careful selection of patients and pre-transplant weight reduction, although the role of weight reduction for improving graft function is not clear.

Ogden CL, Yanovski SZ, Carroll MD, Flegal KM (2007) The epidemiology of obesity. Gastroenterology 132(6):2087–2102. doi:10.1053/j.gastro.2007.03.052 CrossRefPubMed

Eckel RH, Krauss RM (1998) American Heart Association call to action: obesity as a major risk factor for coronary heart disease. AHA Nutrition Committee. Circulation 97(21):2099–2100CrossRefPubMed

Costa B, Moratelli L, Silva LB, Paiva AC, Silva AN, Carminatti M, Bastos MG, Sanders-Pinheiro H (2014) Body mass index in the first year after kidney transplantation. Transplant Proc 46(6):1750–1752. doi:10.1016/j.transproceed.2014.05.021 CrossRefPubMed

Fernandes JF, Leal PM, Rioja S, Bregman R, Sanjuliani AF, Barreto Silva MI, Torres MR (2013) Adiposity and cardiovascular disease risk factors in renal transplant recipients: are there differences between sexes? Nutrition 29(10):1231–1236. doi:10.1016/j.nut.2013.03.019 CrossRefPubMed

Heinbokel T, Floerchinger B, Schmiderer A, Edtinger K, Liu G, Elkhal A, Tullius SG (2013) Obesity and its impact on transplantation and alloimmunity. Transplantation 96(1):10–16. doi:10.1097/TP.0b013e3182869d2f CrossRefPubMed

Beckmann S, Nikolic N, Denhaerynck K, Binet I, Koller M, Boely E, De Geest S, Psychosocial Interest Group STCS (2017) Evolution of body weight parameters up to 3 years after solid organ transplantation: The prospective Swiss Transplant Cohort Study. Clinical transplantation 31 (3). doi:10.1111/ctr.12896

Lavie CJ, McAuley PA, Church TS, Milani RV, Blair SN (2014) Obesity and cardiovascular diseases: implications regarding fitness, fatness, and severity in the obesity paradox. J Am Coll Cardiol 63(14):1345–1354. doi:10.1016/j.jacc.2014.01.022 CrossRefPubMed

Young JB, Neumayer HH, Gordon RD (2010) Pretransplant cardiovascular evaluation and posttransplant cardiovascular risk. Kidney Int Suppl 118:S1–S7. doi:10.1038/ki.2010.209 CrossRef

De Lima JJ, Gowdak LH, de Paula FJ, Muela HC, David-Neto E, Bortolotto LA (2015) Coronary events in obese hemodialysis patients before and after renal transplantation. Clin Transpl 29(11):971–977. doi:10.1111/ctr.12616 CrossRef

10.

Cullen TJ, McCarthy MP, Lasarev MR, Barry JM, Stadler DD (2014) Body mass index and the development of new-onset diabetes mellitus or the worsening of pre-existing diabetes mellitus in adult kidney transplant patients. J Ren Nutr 24(2):116–122. doi:10.1053/j.jrn.2013.11.002 CrossRefPubMed

11.

Kim Y, Kim JR, Choi H, Hwang JW, Jang HR, Lee JE, Kim SJ, Kim YG, Kim DJ, Oh HY, Huh W (2013) Patients with persistent new-onset diabetes after transplantation have greater weight gain after kidney transplantation. J Korean Med Sci 28(10):1431–1434. doi:10.3346/jkms.2013.28.10.1431 CrossRefPubMedPubMedCentral

12.

Tokodai K, Amada N, Kikuchi H, Haga I, Takayama T, Nakamura A (2013) Posttransplant increase of body mass index is associated with new-onset diabetes mellitus after kidney transplantation. Tohoku J Exp Med 229(3):227–232CrossRefPubMed

13.

Chung H, Lam VW, Yuen LP, Ryan BJ, O’Connell PJ, Chapman JR, Hawthorne WJ, Pleass HC (2015) Renal transplantation: better fat than thin. J Surg Res 194(2):644–652. doi:10.1016/j.jss.2013.12.027 CrossRefPubMed

14.

Zrim S, Furlong T, Grace BS, Meade A (2012) Body mass index and postoperative complications in kidney transplant recipients. Nephrology (Carlton) 17(6):582–587. doi:10.1111/j.1440-1797.2012.01621.x CrossRef

15.

Gusukuma LW, Harada KM, Baptista AP, Alencar MR, de Sandes-Freitas TV, Tedesco-Silva H Jr, Medina-Pestana JO (2014) Outcomes in obese kidney transplant recipients. Transplant Proc 46(10):3416–3419. doi:10.1016/j.transproceed.2014.09.112 CrossRefPubMed

16.

Pham PT, Danovitch GM, Pham PC (2013) Kidney transplantation in the obese transplant candidates: to transplant or not to transplant? Semin Dial 26(5):568–577. doi:10.1111/sdi.12109 CrossRefPubMed

17.

Bahde R, Vowinkel T, Unser J, Anthoni C, Holzen JP, Suwelack B, Senninger N, Wolters HH (2014) Prognostic factors for kidney allograft survival in the Eurotransplant Senior Program. Ann Transplant 19:201–209. doi:10.12659/AOT.890125 CrossRefPubMed

18.

Cannon RM, Jones CM, Hughes MG, Eng M, Marvin MR (2013) The impact of recipient obesity on outcomes after renal transplantation. Ann Surg 257(5):978–984. doi:10.1097/SLA.0b013e318275a6cb CrossRefPubMed

19.

Weissenbacher A, Jara M, Ulmer H, Biebl M, Bosmuller C, Schneeberger S, Mayer G, Pratschke J, Ollinger R (2012) Recipient and donor body mass index as important risk factors for delayed kidney graft function. Transplantation 93(5):524–529. doi:10.1097/TP.0b013e318243c6e4 CrossRefPubMed

20.

Hill CJ, Courtney AE, Cardwell CR, Maxwell AP, Lucarelli G, Veroux M, Furriel F, Cannon RM, Hoogeveen EK, Doshi M, McCaughan JA (2015) Recipient obesity and outcomes after kidney transplantation: a systematic review and meta-analysis. Nephrol Dial Transplant 30(8):1403–1411. doi:10.1093/ndt/gfv214 CrossRefPubMed

21.

Kwan JM, Hajjiri Z, Metwally A, Finn PW, Perkins DL (2016) Effect of the obesity epidemic on kidney transplantation: obesity is independent of diabetes as a risk factor for adverse renal transplant outcomes. PLoS One 11(11):e0165712. doi:10.1371/journal.pone.0165712 CrossRefPubMedPubMedCentral

22.

Chan G, Soucisse M (2016) Survey of Canadian kidney transplant specialists on the management of morbid obesity and the transplant waiting list. Can J Kidney Health Dis 3:2054358116675344. doi:10.1177/2054358116675344 CrossRefPubMedPubMedCentral

23.

Stenvinkel P, Ikizler TA, Mallamaci F, Zoccali C (2013) Obesity and nephrology: results of a knowledge and practice pattern survey. Nephrol Dial Transplant 28(Suppl 4):iv99–i104. doi:10.1093/ndt/gft193 CrossRefPubMed

24.

Kieszek R, Kwiatkowski A, Jedrzejko K, Domagala P, Bieniasz M, Wszola M, Drozdrowski J, Tomaszek A, Gozdowska J, Zygier D, Paczek L, Durlik M, Chmura A (2014) Impact of pretransplant body mass index on early kidney graft function. Transplant Proc 46(8):2689–2691. doi:10.1016/j.transproceed.2014.09.050 CrossRefPubMed

25.

Mos F, Roberti J, Fasce N, Paz M, Cicora F (2014) Renal transplantation in obese patients: experience in an Argentine center. Transplant Proc 46(9):2981–2983. doi:10.1016/j.transproceed.2014.07.004 CrossRefPubMed

26.

Pieloch D, Dombrovskiy V, Osband AJ, Lebowitz J, Laskow DA (2014) Morbid obesity is not an independent predictor of graft failure or patient mortality after kidney transplantation. J Ren Nutr 24(1):50–57. doi:10.1053/j.jrn.2013.07.001 CrossRefPubMed

27.

Tremblay S, Kaiser TE, Alloway RR, Woodle ES, Diwan TS (2016) Absence of the effect of pretransplant body mass index on post kidney transplant outcomes. Prog Transplant 26(2):183–190. doi:10.1177/1526924816640679 CrossRefPubMed

28.

Krishnan N, Higgins R, Short A, Zehnder D, Pitcher D, Hudson A, Raymond NT (2015) Kidney transplantation significantly improves patient and graft survival irrespective of BMI: a cohort study. Am J Transplant 15(9):2378–2386. doi:10.1111/ajt.13363 CrossRefPubMed

29.

Yarlagadda SG, Coca SG, Garg AX, Doshi M, Poggio E, Marcus RJ, Parikh CR (2008) Marked variation in the definition and diagnosis of delayed graft function: a systematic review. Nephrol Dial Transplant 23(9):2995–3003. doi:10.1093/ndt/gfn158 CrossRefPubMedPubMedCentral

30.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral

31.

Lynch RJ, Ranney DN, Shijie C, Lee DS, Samala N, Englesbe MJ (2009) Obesity, surgical site infection, and outcome following renal transplantation. Ann Surg 250(6):1014–1020. doi:10.1097/SLA.0b013e3181b4ee9a CrossRefPubMed

32.

Olarte IG, Hawasli A (2009) Kidney transplant complications and obesity. Am J Surg 197(3):424–426. doi:10.1016/j.amjsurg.2008.11.021 CrossRefPubMed

33.

Bennett WM, McEvoy KM, Henell KR, Pidikiti S, Douzdjian V, Batiuk T (2011) Kidney transplantation in the morbidly obese: complicated but still better than dialysis. Clin Transpl 25(3):401–405. doi:10.1111/j.1399-0012.2010.01328.x CrossRef

34.

Patel S, Pankewycz O, Kohli R, Said M, Alnimri M, Feng L, Laftavi MR (2011) Obesity in renal transplantation: the role of induction therapy on long-term outcomes. Transplant Proc 43(2):469–471. doi:10.1016/j.transproceed.2011.01.040 CrossRefPubMed

35.

Gill JS, Lan J, Dong J, Rose C, Hendren E, Johnston O, Gill J (2013) The survival benefit of kidney transplantation in obese patients. Am J Transplant 13(8):2083–2090. doi:10.1111/ajt.12331 CrossRefPubMed

36.

Smith CT, Katz MG, Foley D, Welch B, Leverson GE, Funk LM, Greenberg JA (2015) Incidence and risk factors of incisional hernia formation following abdominal organ transplantation. Surg Endosc 29(2):398–404. doi:10.1007/s00464-014-3682-8 CrossRefPubMed

37.

Lafranca JA, Ijermans JN, Betjes MG, Dor FJ (2015) Body mass index and outcome in renal transplant recipients: a systematic review and meta-analysis. BMC Med 13:111. doi:10.1186/s12916-015-0340-5 CrossRefPubMedPubMedCentral

38.

Molnar MZ, Kovesdy CP, Mucsi I, Bunnapradist S, Streja E, Krishnan M, Kalantar-Zadeh K (2011) Higher recipient body mass index is associated with post-transplant delayed kidney graft function. Kidney Int 80(2):218–224. doi:10.1038/ki.2011.114 CrossRefPubMedPubMedCentral

39.

Ditonno P, Lucarelli G, Impedovo SV, Spilotros M, Grandaliano G, Selvaggi FP, Bettocchi C, Battaglia M (2011) Obesity in kidney transplantation affects renal function but not graft and patient survival. Transplant Proc 43(1):367–372. doi:10.1016/j.transproceed.2010.12.022 CrossRefPubMed

40.

Locke JE, Reed RD, Massie A, MacLennan PA, Sawinski D, Kumar V, Mehta S, Mannon RB, Gaston R, Lewis CE, Segev DL (2017) Obesity increases the risk of end-stage renal disease among living kidney donors. Kidney Int 91(3):699–703. doi:10.1016/j.kint.2016.10.014 CrossRefPubMed

41.

Foster MC, Hwang SJ, Larson MG, Lichtman JH, Parikh NI, Vasan RS, Levy D, Fox CS (2008) Overweight, obesity, and the development of stage 3 CKD: the Framingham heart study. Am J Kidney Dis 52(1):39–48. doi:10.1053/j.ajkd.2008.03.003 CrossRefPubMedPubMedCentral

42.

Hanley MJ, Abernethy DR, Greenblatt DJ (2010) Effect of obesity on the pharmacokinetics of drugs in humans. Clin Pharmacokinet 49(2):71–87. doi:10.2165/11318100-000000000-00000 CrossRefPubMed

43.

Bouquegneau A, Vidal-Petiot E, Moranne O, Mariat C, Boffa JJ, Vrtovsnik F, Scheen AJ, Krzesinski JM, Flamant M, Delanaye P (2016) Creatinine-based equations for the adjustment of drug dosage in an obese population. Br J Clin Pharmacol 81(2):349–361. doi:10.1111/bcp.12817 CrossRefPubMedPubMedCentral

44.

Wu D, Dawson NA, Levings MK (2016) Obesity—associated adipose tissue inflammation and transplantation. Am J Transplant 16(3):743–750. doi:10.1111/ajt.13578 CrossRefPubMed

45.

Mehta R, Shah G, Leggat JE, Hubbell C, Roman AM, Kittur DS, Narsipur SS (2007) Impact of recipient obesity on living donor kidney transplant outcomes: a single-center experience. Transplant Proc 39(5):1421–1423. doi:10.1016/j.transproceed.2007.02.084 CrossRefPubMed

46.

Papalia T, Greco R, Lofaro D, Maestripieri S, Mancuso D, Bonofiglio R (2010) Impact of body mass index on graft loss in normal and overweight patients: retrospective analysis of 206 renal transplants. Clin Transpl 24(6):E241–E246. doi:10.1111/j.1399-0012.2010.01258.x CrossRef

47.

Abou-Jaoude MM, Nawfal N, Najm R, Honeidi M, Shaheen J, Almawi WY (2010) Effect of pretransplantation body mass index on allograft function and patient survival after renal transplantation. Transplant Proc 42(3):785–788. doi:10.1016/j.transproceed.2010.03.026 CrossRefPubMed

48.

Hadjievangelou N, Kulendran M, McGlone ER, Reddy M, Khan OA (2016) Is bariatric surgery in patients following renal transplantation safe and effective? A best evidence topic. Int J Surg 28:191–195. doi:10.1016/j.ijsu.2016.02.095 CrossRefPubMed

49.

Kienzl-Wagner K, Weissenbacher A, Gehwolf P, Wykypiel H, Ofner D, Schneeberger S (2017) Laparoscopic sleeve gastrectomy: gateway to kidney transplantation. Surg Obes Relat Dis. doi:10.1016/j.soard.2017.01.005 PubMed

50.

Mucha K, Foroncewicz B, Ryter M, Florczak M, Krajewska M, Mulka-Gierek M, Jabiry-Zieniewicz Z, Chmura A, Lisik W, Nazarewski S, Paczek L (2015) Weight gain in renal transplant recipients in a Polish single centre. Ann Transplant 20:16–20. doi:10.12659/AOT.892754 CrossRefPubMed

51.

Kugler C, Einhorn I, Gottlieb J, Warnecke G, Schwarz A, Barg-Hock H, Bara C, Haller H, Haverich A (2015) Postoperative weight gain during the first year after kidney, liver, heart, and lung transplant: a prospective study. Prog Transplant 25(1):49–55. doi:10.7182/pit2015668 CrossRefPubMed

52.

Kurnatowska I, Malyska A, Wysocka K, Mazur K, Krawczyk J, Nowicki M (2016) Long-term effect of body mass index changes on graft damage markers in patients after kidney transplantation. Ann Transplant 21:626–631CrossRefPubMed

Title: Influence of the recipient body mass index on the outcomes after kidney transplantation
Authors: Juliane Liese
Nils Bottner
Stefan Büttner
Alexander Reinisch
Guido Woeste
Markus Wortmann
Ingeborg A. Hauser
Wolf Otto Bechstein
Frank Ulrich
Publication date: 01-02-2018
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 1/2018
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-017-1584-7

At a glance: The STEP trials

Springer Medicine

Influence of the recipient body mass index on the outcomes after kidney transplantation

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

Liver resection for HCC outside the BCLC criteria

Predictors of multiglandular disease in primary hyperparathyroidism

Preoperative optimization for major hepatic resection

Indication of extrahepatic bile duct resection for gallbladder cancer

The combination of mitomycin-induced blood cells with a temporary treatment of ciclosporin A prolongs allograft survival in vascularized composite allotransplantation

Postoperative outcome and quality of life after surgery for FAP-associated duodenal adenomatosis